| NPI | 1063954923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 57362) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN664884) |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2021-03-15 |